Bipolar Disorder and Drug Use

It is not uncommon for you or anyone with Bipolar Disorder to 'self medicate' with a drug or alcohol.  You may have initially reached slipped into using a drug or alcohol to address your anxiety or depression unknowingly. This strategy is, of course, ineffective and makes the psychological and physical dependency on these substances all the more severe. This also promotes ongoing symptoms to progress at the expense of all the relationships of your life.  It also adds to the impairment, potentially permanent, to your mental processing speed. In the following section we will discuss four important considerations when helping to distinguish between Bipolar symptoms and the symptoms of drug addiction.

Bipolar Disorder and Drug Use: Considerations when Offering Assistance

1. Looking for help for your Bipolar symptoms while actively abusing drugs or alcohol presents a number of problems. Your first priority must be to find the support needed to optimize your health, gain sobriety, and return to your life of personal growth and contribution. What others will need to provide you optimal support are multiple points of view from several time periods in your past and present. You will likely not remember or fully realize that you were at times not yourself and suffering symptoms of this illness. (Truly, almost none remembers these events acurately)

If you want to assess your life for potential signs of this illness the following may prove helpful.

1) An extensive family history is a must.  Ask questions regarding all available adult and teenage relatives. Recording carefully the symptoms of those relatives who have describe suffering mood swings, problems with anger, multiple life changes (divorces/jobs), multiple legal issues or risky behaviors can be very illuminating. A general rule of thumb in such investigations is, "If you don’t know, ask someone. If they don’t know, then ask someone else." Then, going a step further, ask if they were ever evaluated, and if so, were they given a diagnosis? Finally, find out what treatments they were offered and what were the results of these treatments. Asking the right questions, and thoroughly researching for answers can save you years of fruitless searching for your answer!! As an aside, I don’t believe in telling others about things they will never understand. I do believe it to be very beneficial to let appropriate blood family members know your diagnosis, symptoms and what has been helpful to you and your family. This simple information shared thoughtfully can change and possibly save lives.

2. You can also look into what was going on in your life before you began using drugs or alcohol. Is there any evidence that the illness had already begun? Was there an unexplained or exaggerated change in behavior in your early or late teen years? Did you school grades drop precipitously for no apparent reason? (Other than someone else was a jerk! Yes, we tend to see things from our own point of view!) Was there a defiant type relationship change in your home home? Did you become involved in activities or behaviors that would have been previously entirely out of character? Given that neurobiologically, 'like attracts like', did your friends change during this period to time? Did your previous friends seem 'square' or give up on you? Have any of your  friends been diagnosed with Bipolar Disorder? Did you or they ever intentionally cut themselves to feel better? Did they or you fall into seemingly desperate intimate relationships that make little sense? Were the people in these relationships subsequently diagnosed with Bipolar or another mood disorder? Did they respond to treatment? In my experience, responders to particular treatments are attracted to others who also responder to similar treatments.

3. What is your drug or drugs of choice? Neurobiologically the Nucleus Accumbens, which is involved in Bipolar symptoms is itself modulated by opiates (pain medications). Many people who suffer Bipolar symptoms find opiates dull the irritability of a mixed manic episode. Of course, tolerance develops and over time the dose of the opioid needs to be increased and eventually stops 'working'. This leaves a person with their illness and a drug problem!

Alcohol is also often used knowingly or unknowingly to quiet the accompanying anxiety with similar painful results. Marijuana may also be used but this frequently leads to paranoia. This is particularly true when the MJ is laced with other substances. 'Spice' is yet another drug that has entered the scene and is particularly destructive to the brain. Although these drugs lead to worsening outcome, it may be helpful to you to understand why you fell into this trap. It also allows for a logical course of action to get your life and happiness back! Please know, many of the strategies you will learn are those we all need to be learning to lead lives of sustained joy and success. Much like a diabetic who must eat well, you and they must each day live well! This is a major premise of the Oneness Approach. Please see the 'Patients of Oneness' portion of the website.

4. Another question to explore is when you use your drug of choice, what does it do for you? Why does it feel like you need it, apart from avoiding withdrawal? Are these 'needs' reminiscent of a high or low energy Bipolar mood episode? Is there a time of year or season when your use seems to increase? What symptoms seem to be more evident during these times of year? Winter depression and Spring/Fall switches into irritable states are not unusual.

Does the struggle with some of these symptoms occur more in the morning even when covered by your drug of choice? This illness is frequently worse in the morning. When you attempt to stop the drug for more than a month, are there symptoms that seem to come out and drive you back into using again? At times all you may remember it that you felt bad.  Try to slow your thoughts about these times down. Go back to the exact time you last started using. Describe the room, the people present where and when it began. Then slowly go back the previous 24-48 hours. Have someone help you if they are available. Over the previous week, what was going on with your sleep? How did you feel in the mornings? Listen and record carefully the words you use to describe these feelings.  Ask others who know you well about these same time periods. Friends and family members will likely be able to help. Who do you like and hang around with? Have others sharing your life, particularly friends been diagnosed with Bipolar Disorder or other symptoms clusters that include mood swings?

Some may question whether you are able to safely handle medications someone with Bipolar Disorder while actively abusing drugs or alcohol. Clearly there are safety issues and medications must be chosen, prescribed, stored and handled carefully. There are many issues to consider including your available supports and safety issues surrounding the combining of medications with the wide variety of drugs and alcohol that may be entering your body. There is also the issue of decreased efficacy of medications with drug use. However, for many, without medications, chances for survival, much less improvement, are slim. The suicide rate for those with untreated Bipolar Disorder and chemical dependency approaches fifty percent.

Rejecting the Idea of Medication

I’d like to mention in this section one more tendency you may have noticed in yourself. It is not unusual to refuse to take any medication. Confusingly you may feel that you don’t want to take something that might change who you are.” This may seem…difficult for others to accept given what you are already putting into your body. But there are several issues at hand. When you take your drug of choice, at least for a time you may feel more like yourself. Or, you may feel like what you have come to know as yourself. Additionally, if they have received any treatment in the past from a doctor, you likely misdiagnosed given an antidepressant leaving you feeling worse. Then when the first antidepressant failed, you were likely given another antidepressant, and again, felt terrible. This may have been frustrating to everyone involved. The end result is often people blaming you for ‘not trying hard enough’.

Yet another confusing issue is that you may act much as you did when your illness began. It's hard to learn what works for you in life when your moods are jumping all over the place. This is also much like chemical dependency. Since this usually begins in adolescence it should not be too surprising that you may struggle when told to follow a structure given by any boos or other authority figure. Finding a psychiatrist and therapist familiar with all of these issues can help you find your unique answers. It makes your relationship with them more understandable, respectable or at least more palatable!

Included in such discussions are the effective non-medical treatment options that take into account a more wholistic view of life.  Not being too certain that any one option will work is useful in such a search. Many times it takes several trails of variable treatments to find the one that works for you. Also knowing that you are not alone can be helpful. Actively participate in investigating your options. Take an active part in the decision-making. It is your life, this practice will help you in the future. It will also demonstrates to everyone involved your resolve. Be honest, but make it 'nicely honest' with your supports. Be encouraging of the intent of your supports while admitting to the difficulties that everyone is facing.

Bipolar Disorder and Co-occurring Disorders
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